Single dose oral dihydrocodeine for acute postoperative pain

Abstract

Background This is an updated version of the original Cochrane review published in Issue 2, 2000. Dihydrocodeine is a synthetic opioid analgesic developed in the early 1900s. Its structure and pharmacokinetics are similar to that of codeine and it is used for the treatment of postoperative pain or as an antitussive. It is becoming increasingly important to assess the relative efficacy and harm caused by different treatments. Relative efficacy can be determined when an analgesic is compared with control under similar clinical circumstances. Objectives To quantitatively assess the analgesic efficacy and adverse effects of single-dose dihydrocodeine compared with placebo in randomised trials in moderate to severe postoperative pain. Search methods Published reports were identified from electronic databases (MEDLINE, EMBASE, CENTRAL, the Oxford Pain Relief Database in December 2007, the original search was conducted in October 1999). Additional studies were identified from the reference lists of retrieved reports. Selection criteria Inclusion criteria: full journal publication, clinical trial, random allocation of participants to treatment groups, double blind design, adult participants, baseline pain of moderate to severe intensity, postoperative administration of study drugs, treatment arms which included dihydrocodeine and placebo and either oral or injected (intramuscular or intravenous) administration of study drugs. Data collection and analysis Data collection and analysis: summed pain intensity and pain relief data over four to six hours were extracted and converted into dichotomous information to yield the number of participants obtaining at least 50% pain relief. This was used to calculate relative benefit and number-needed-to-treat-to-benefit (NNT) for one participant to obtain at least 50% pain relief. Single-dose adverse effect data were collected and used to calculate relative risk and number-needed-to-treat-to-harm (NNH). Main results Fifty-two reports were identified in the original review as possible randomised trials which assessed dihydrocodeine in postoperative pain. Four reports met the inclusion criteria; all assessed oral dihydrocodeine. Three reports (194 participants) compared dihydrocodeine with placebo and one (120 participants) compared dihydrocodeine (30 mg or 60 mg) with ibuprofen 400 mg. For a single dose of dihydrocodeine 30 mg in moderate to severe postoperative pain the NNT for at least 50% pain relief was 8.1 (95% confidence interval 4.1 to 540) when compared with placebo over a period of four to six hours. Pooled data showed significantly more participants to have reported adverse effects with dihydrocodeine 30 mg than with placebo. When compared to ibuprofen 400 mg both dihydrocodeine 30 mg and 60 mg were significantly inferior. No additional studies were found for this update. Authors’ conclusions A single 30 mg dose of dihydrocodeine is not sufficient to provide adequate pain relief in postoperative pain. Statistical superiority of ibuprofen 400 mg over dihydrocodein...

Relative efficacy of oral analgesics after third molar extraction – a 2011 update

“…The resultant NNT was 6, far worse than available for drugs in Table 1, and far worse than ibuprofen 400 mg in the only direct comparison. 6 The Cochrane overview concluded that the results for dihydrocodeine were not robust because of the smallness of the data set available, and that unpublished results from just 46 patients in zero effect trials would be needed to make any result clinically irrelevant.…”

Paracetamol (acetaminophen) with or without codeine or dihydrocodeine for neuropathic pain in adults

“…There is good evidence showing that paracetamol plus codeine combinations are effective in acute pain (Toms 2009), but limited evidence for cancer pain . Dihydrocodeine was not effective in acute postoperative pain (Moore 2000), and there is very little evidence on its efficacy in other pain conditions. Codeine is not effective in acute postoperative pain (Derry 2010).…”

Opioids in clinical practice

“…It plays a role in the treatment of moderate, chronic pain as well as cough, diarrhoea, and opioid addiction [30,31]. DHC displays superior analgesia, less fatigue, sleep disturbance, nausea, and vomiting, and better appetite in comparison to tramadol [32]. In some studies, single 30 mg and 60 mg doses of DHC did not provide desirable analgesia in postoperative pain whereas 400 mg ibuprofen provided statistically superior analgesia [33].…”

“…Odgrywa ona rolę w leczeniu umiarkowanego, przewlekłego bólu, a także kaszlu, biegunki i uzależnienia od opioidów [30,31]. Charakteryzuje się lepszą analgezją, zmniejszonymi objawami: zmęczenia, zaburzeń snu, nudności, wymiotnymi, oraz lepszym apetytem w porównaniu z tramadolem [32]. W niektórych badaniach pojedyncze dawki 30 mg i 60 mg dihydrokodeiny nie zapewniły pożądanej analgezji w bólu pooperacyjnym, natomiast ibuprofen w dawce 400 mg zapewniał analgezję statystycznie lepszą [33].…”